- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.77 / $1,456.77 / $8,553.50
| Professional | | $1,456.77 | $1,456.77 | $8,553.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,461.16 / $11,467.05 / $21,526.57
| Facility | | $8,461.16 | $11,467.05 | $21,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.83 / $2,408.25 / $3,211.00
| Professional | | $1,412.83 | $2,408.25 | $3,211.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,944.19 / $3,658.80 / $4,798.84
| Professional | | $2,944.19 | $3,658.80 | $4,798.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.52 / $2,549.35 / $7,856.00
| Facility | | $1,676.52 | $2,549.35 | $7,856.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,939.87 / $3,660.39 / $14,521.57
| Professional | | $1,939.87 | $3,660.39 | $14,521.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.00 / $3,669.05 / $4,908.08
| Facility | | $2,833.00 | $3,669.05 | $4,908.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,301.05 / $3,658.80 / $4,798.84
| Professional | | $2,301.05 | $3,658.80 | $4,798.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $2,256.30 / $4,292.50
| Professional | | $11.00 | $2,256.30 | $4,292.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.85 / $3,477.45 / $4,178.18
| Professional | | $2,044.85 | $3,477.45 | $4,178.18 |